Diagnosis of childhood tuberculosis in Pakistan: Are national guidelines used by private healthcare providers?

• Main Authors: Aashifa Yaqoob, Sven Gudmund Hinderaker, Razia Fatima, Hemant D. Shewade, Nadia Nisar, Ahmed Wali
• Format: Article
• Language: English
• Published: Elsevier 2021-06-01
• Series: International Journal of Infectious Diseases
• Subjects: Tuberculosis; Children; Diagnosis; Guidelines; PPA scoring chart; Private providers
• Online Access: http://www.sciencedirect.com/science/article/pii/S1201971221003672

Background: The National Tuberculosis Control Program (NTP) in Pakistan developed, with the Pakistan Paediatric Association, a pediatric scoring chart to aid diagnosis of childhood tuberculosis (TB). Our study compared the diagnostic practice of private healthcare providers in Pakistan with the NTP guidelines. Methods: A cross-sectional study comparing diagnosis of TB in children <15 years by Non-NTP private providers with the NTP’s pediatric scoring chart. A generalized linear model was used to determine the difference in adherence by Non-NTP private providers to the NTP guidelines for childhood TB diagnosis by associated factors. Results: A total of 5193 (79.7% of presumptive childhood TB cases identified in the selected districts during the study) children were diagnosed with TB by Non-NTP private providers. A strong clinical suspicion of TB was present in 17.3%, and chest x-ray was suggestive of TB in 34.3%. The Kappa score between Non-NTP private providers and the NTP guidelines for diagnosing TB was 0.152. Only 47.8% of cases were diagnosed in line with the NTP guidelines. Children <5 years old with a history of TB contact had a higher chance of being diagnosed according to the NTP guidelines. Conclusion: This study indicates a low adherence of NTP guidelines for diagnosing childhood TB by private providers in Pakistan.